What to expect from the stage leading up to menopause.
The Change happens slowly, then all at once—and not in a good way. Menopause is one of the biggest shifts that menstruating people experience in their lives, and unfortunately, it’s a process that happens over the span of a few years. But what you think of menopause and all of its side effects—the hot flashes, night sweats, etc.—isn’t actually menopause. Those symptoms are far more likely to occur leading up to menopause, in a period called perimenopause.
You might sometimes hear the phrase premenopause, but this can be a bit of a misnomer; “premenopause” describes the time before your body starts showing signs of menopause. So if you get your period (or normally would, but don’t because of your birth control), you’re in premenopause. Perimenopause is when things start to feel a lot different.
When perimenopause sets in
According to the Cleveland Clinic, menopause typically happens in your early 50s (though timelines can vary slightly depending on the individual), but perimenopause can start eight to 10 years before this. During this period, you still have menstrual cycles and can get pregnant, but your ovaries will gradually produce less estrogen, with hormone levels rapidly dropping in the last two years before menopause. Fertility also decreases at this time and periods can become more irregular, until they totally stop with menopause.
Over these years, people can experience a wide range of symptoms, though Johns Hopkins Medical notes that no two individuals will likely experience perimenopause in the exact same way. Some symptoms include mood swings, hot flashes, night sweats, headaches, and joint aches. And then—of course—there are the side effects that can totally change how you approach intimacy.
How perimenopause affects your sex life
The drop in estrogen that occurs during perimenopause, and particularly the years right before menopause, is a big reason why menopause has earned a bad reputation for ruining sex lives—and pretty rightly so. According to the Marion Gluck Clinic, which specializes in hormonal health, this can result in a plummeting sexual drive. Not to mention, reduced blood flow to the vagina can cause dryness that makes intercourse uncomfortable. Johns Hopkins Medical reports that a third of perimenopausal women experience sexual difficulties, whether that means they’re having a hard time reaching orgasm or they just aren’t in the mood for sex. One 2017 study showed that decline in sexual function begins 20 months before the final menstrual period and slows for about five years after, post-menopause.
That’s not to say that sex is off the table during perimenopause, though. Another 2018 paper found that female subjects expressed a desire to maintain a healthy sex life during perimenopause and menopause, yet were reluctant to bring up sexual difficulty or dysfunction with their healthcare providers—making it impossible for them to prescribe any kind of treatment, like hormone therapy or even just the use of a good lube, that can combat side effects like vaginal dryness that might directly impact their sex lives.
Perimenopause is a stressful time, but sex, after all, is a stress-reliever—and a moment of release can do you a whole lot of good, whether that’s with a partner or a good old vibe. As the National Women’s Health Network points out, intimacy doesn’t have to mean intercourse, and a healthy sex life—through whatever means are comfortable to you—can make this time way more bearable.